Surgery to remove the tumor, preferably by the same surgeon who did the biopsy. If cancer is found at the edge of the surgery specimen (meaning some cancer might have been left behind), a second surgery might be done to try to remove any remaining cancer. Radiation therapy might be given to the area as well.

More chemo (for up to a year). If the initial chemo killed most of the cancer cells, the same drugs are often given again after surgery. If the initial chemo didn’t work well, different drugs might be tried.

Chemotherapy is an important part of treatment for these cancers. Even when imaging tests don’t show that the cancer has spread to distant areas, many patients are likely to have very small areas of cancer spread that can’t be detected with tests. If chemotherapy isn’t given, the cancer is more likely to come back after surgery.

In rare cases, surgery might be the first treatment (before chemo), especially for people who are elderly.

Low grade: A small number of osteosarcomas are low grade, meaning they are likely to grow slowly. Patients with low-grade, resectable osteosarcomas can often be cured with surgery alone (without chemotherapy). However, if the tumor removed by surgery is found to be high grade, chemotherapy might be recommended.

Localized, non-resectable osteosarcoma

These cancers have not been found to have spread to other parts of the body, but they can’t be removed (resected) completely by surgery. For example, they may be too large or too close to vital structures in the body to be resected completely.

As with other osteosarcomas, a biopsy is needed first to establish the diagnosis.

Chemotherapy is usually the first treatment for these cancers. If the tumor shrinks enough to become resectable it will be removed with surgery. This is followed by more chemotherapy for up to a year.

If the tumor is still unresectable after chemotherapy, radiation therapy can often be used to try to keep the tumor under control and to help relieve symptoms. This may be followed by more chemotherapy.

Metastatic osteosarcoma

These cancers have already been found to have spread to distant parts of the body when they are diagnosed. Most often they have spread to the lungs. As with other osteosarcomas, a biopsy is needed first to establish the diagnosis.

Chemotherapy is usually the first treatment for these cancers. If all of the tumors are thought to be resectable after chemotherapy, they are removed with surgery, sometimes in more than one operation. This is followed by more chemo for up to a year.

If some of the tumors remain unresectable after chemo, radiation therapy can often be used to try to keep them under control and to help relieve symptoms. This may be followed by more chemo.

Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option in many cases.

Recurrent osteosarcoma

Recurrent cancer means that the cancer has come back after treatment. It may come back locally (near where the first tumor was) or in distant organs. Most of the time, if osteosarcoma recurs it will be in the lungs.

If possible, surgery to remove the tumor(s) is the preferred treatment, as it offers the best chance for long-term survival. If the cancer recurs at the original site on an arm or leg after limb-sparing surgery, amputation of the limb may be recommended.

Chemotherapy may be used for recurrent cancers as well, although its role in these cases is not clearly defined. If the cancer is not resectable, radiation therapy may also be used to help keep its growth in check and help relieve symptoms. Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option.